Stress vs Anxiety: Understanding the Difference

Stress and anxiety go together so often that the two terms are used interchangeably, but there are differences between the two. Stress is a normal bodily response cued by the brain and nervous system, and usually is triggered by an event or situation. Anxiety is a psychological condition that can develop when the stress response occurs too often, lasts too long, and is disproportionate to the situation.

Stress and anxiety operate like a continuous feedback loop where each can reinforce the other, but stress is considered the initial response, and anxiety a secondary response.² Within the brain and nervous system, stress and anxiety are almost indistinguishable from one another.³ To determine the difference between stress and anxiety, the anxiety or stress response needs to be evaluated in the context in which it occurred.

When the intensity of the response seems appropriate and subsides soon after the situation improves, this is probably a stress response. When the response seems like an overreaction to the situation and persists even after circumstances change, this is more likely to be anxiety. Anxiety is often suspected in cases where there is a pattern of excessive stress and worry that isn’t just situational in nature.

Signs & Symptoms of Stress

Stress is a normal human response to situations that are challenging, uncertain, or upsetting. Some signs of stress are a racing heartbeat, difficulty breathing, sweating, or dizziness.

On a physiological level, stress describes the following chain of events:³

1. Something happens that acts as a triggering event, and is usually something upsetting, challenging, scary, or at least unsettling
2. The amygdala, which is like the brain’s threat detection system, registers this situation, circumstance or event as a threat. It sends a signal to the hypothalamus.
3. The hypothalamus, which operates like a command center in the brain, activates the sympathetic nervous system.
4. The sympathetic nervous system is activated, which is often likened to pressing the body’s “gas pedal” because it provides a surge of energy, releasing adrenaline and cortisol into the bloodstream.
5. Adrenaline and cortisol increase heart rate, respiration, and blood pressure and send additional oxygen to the brain to increase alertness and sharpen senses. These chemicals also cause people to experience a surge of physical energy.

This sequence of physiological changes is referred to as the “fight or flight” response, and is a survival instinct encoded into humans. The rush of energy and sharpening of senses is essentially readying the mind and body for an attack, providing the acuity, strength and speed to either outrun, outsmart or overpower a predator.³ The problem is that the majority of the “threats” that activate this response in modern times are not ones we can fight off, outmaneuver, or run away from.

Any number of relatively harmless situations could trigger this fight or flight response, including needing to speak up in a meeting, getting blood drawn, seeing a spider, or going on a blind date.

The end result is an unhelpful and uncomfortable physiological response that can manifest in the body in the following ways:

• Racing heart
• Difficulty breathing or hyperventilating
• Sweating, hot or cold chills
• Feeling shaky or unstable
• Feeling dizzy or head spinning
• Nausea, abdominal pain or upset stomach
• Tense muscles
• Tightness or pain in the chest
• Feeling choked or suffocated
• Tingling sensations
• Restlessness or unstable surges of energy
• Heightened senses

Signs & Symptoms of Anxiety

Anxiety is essentially a secondary stress response. Anxiety occurs when the fight or flight response is triggered by a “false alarm,” or when the response outlasts the situation causing the response.² Anxiety could be thought of as a more chronic stress response that tends to be easily activated but not easily deactivated. When the fight or flight mechanism remains activated for longer periods of time, there can be more complex reactions that occur.

Some of the symptoms of anxiety are experienced in the body, and many are the same as those listed under the stress response. Things like a racing heart, shortness of breath, shakiness, sweating, or dizziness are common features of anxiety, and many are even classified as symptoms of certain anxiety disorders. In addition to these physiological changes, anxiety also includes emotional and cognitive effects.

Some of the more common psychological symptoms of anxiety include:¹

• Mind racing or going completely blank
• Nervousness and worrying that is hard to control
• Difficulty focusing or concentrating
• Worst-case-scenario and “what-if” thinking
• Feelings of dread or panic
• Irritability or snappiness
• Difficulty focusing and concentrating
• Feeling disconnected or out of it
• Hypervigilance (over-aware of surroundings)
• Feeling restless, jumpy, or on-edge
• Exhaustion or fatigue
• Insomnia or feeling unrested after sleep

The Difference Between Normal and Abnormal Anxiety

Anxiety is normal up to a certain point. Feeling nervous, worried or scared is an experience that everyone has, and sometimes these fears are even irrational or excessive, which is also normal. Experiencing occasional situational anxiety does not mean a person has an anxiety disorder.

Anxiety disorders are mental health conditions that are only diagnosed when the symptoms become frequent and excessive, and begin to interfere with some aspect of a person’s life or ability to function. There are several different kinds of anxiety disorders, but all share common symptoms of excessive fear or worrying that becomes limiting in some way. Often, impairments and limitations are the direct result of unhelpful avoidance and control behaviors.

Some of the common types of anxiety disorders are:¹

• Generalized anxiety disorder: This disorder describes excessive nervousness and worry in response to many different situations, and sometimes even when there is no identifiable trigger.
• Specific phobias: Specific phobias are anxiety disorders in which there is a specific fear that triggers the anxiety and avoidant behaviors (i.e. arachnophobia or claustrophobia).
• Social anxiety disorder: This condition is when the anxiety is related to social situations and interactions, and is usually driven by an intense fear of being judged, embarrassed, or rejected by others.
• Panic disorder: Panic attacks are sudden and intense symptoms of anxiety that typically last a few minutes, and panic disorder is a condition where these attacks have become more regular. People with panic disorder are preoccupied with a fear of having another panic attack, avoiding places and situations because of this fear.
• Obsessive Compulsive Disorder (OCD): OCD was reclassified in 2013 and is no longer officially called an anxiety disorder,¹ but excessive and irrational fear and worrying are features of both OCD and anxiety disorders. People with OCD engage in rigid routines and behaviors to alleviate anxiety about thoughts that scare or upset them.
• Posttraumatic Stress Disorder (PTSD): As of 2013, PTSD is also not technically an anxiety disorder, but is a condition which features high levels of anxiety.¹ People with PTSD have experienced something traumatic and become intensely afraid when something triggers a memory of the traumatic event.

Stress vs Anxiety: Similarities & Differences

Stress and anxiety are closely linked, and have an interdependent relationship where each can cause and exacerbate the other. Still, they are slightly different and can be experienced independent of one another.

Stress tends to rise and fall according to external stressors, while this isn’t always the case with anxiety. Stress also describes more of a physiological response caused by the brain and nervous system, while anxiety is a psychological response that also includes changes in the way a person thinks, feels and behaves.²

Similarities Between Stress & Anxiety

Within the brain and body, stress and anxiety are both products of the fight or flight mechanism, which involves the activation of the nervous system and the release of adrenaline and cortisol. Because of this, both cause similar physiological effects, and some people experience stress and anxiety in the same way.

Both stress and anxiety occur normally in people, but can become chronic in nature. Research indicates that stress is more likely to become chronic in nature when the situation triggering it is unpredictable and not within a person’s control, which is also true for anxiety disorders.⁵ When stress or anxiety become chronic, both can have similar detrimental effects on a person’s physical and mental health.

The harmful effects of both stress and anxiety include:⁴

• Lowered immune system
• Higher rates of inflammation in the body
• Increased cardiovascular risk
• Difficulty with learning, memory, and thinking
• Increased vulnerability for mental illness
• Problems with sleep

At lower levels, both stress and anxiety are not only normal, they can actually be helpful. People who say they “work better under pressure,” for instance, experience stress as motivating. Low to moderate levels of stress hormones and chemicals (like norepinephrine and cortisol) are even needed even for the most basic bodily functions, as well as to provide energy for tasks.

Because unpredictable stressors that are not within a person’s control are more likely to lead to chronic stress, good stress and anxiety tend to come from situations that are somewhat predictable or within our control.⁵

Key Differences Between Stress & Anxiety

While stress and anxiety both are products of the same chain of events and create similar effects in the body, anxiety has a broader reach. Stress is a physiological response but anxiety is also psychological in nature. All psychological disorders involve changes in a person’s thoughts, emotions, and actions, as well as sometimes causing physical sensations. The psychological changes that occur when a person is anxious are secondary to the initial physiological stress response.

Some of the psychological symptoms that differentiate anxiety from stress include:¹

• The emotional experience of fear or nervousness
• Feelings of dread and apprehension
• Irritability and a tendency to be more on-edge
• Difficulty focusing and concentrating
• Worrying about worst-case scenarios
• Feeling distracted, disconnected, or detached
• Restlessness or feeling wired
• Being more exhausted or fatigued than usual

Chronic anxiety is often indicative of an underlying condition, while chronic stress is typically more reflective of a person’s external circumstances. People struggling with an anxiety disorder often find that their symptoms worsen when they are under more stress, but can also experience symptoms when they are not under stress.

While stress can lead to anxiety or worsen existing anxiety, this isn’t true for all people. Some people who experience stress (even at high levels) do not develop symptoms of anxiety.

Finally, a major difference between stress and anxiety is that anxiety is experienced as fear (which at low levels is feeling nervous or worried and at high levels feeling panicked) while stress doesn’t always manifest this emotion. For some people, stress can just feel like being under pressure or feeling overwhelmed, especially at lower levels.

Treatment for Anxiety & Stress

While there is not an official diagnosis for chronic stress, many people experiencing it benefit from counseling. Because chronic stress is often a response to difficult life circumstances or transitions, people experiencing psychological effects of stress may be diagnosed with an adjustment disorder.

An adjustment disorder is a temporary diagnosis given to people who experience situational anxiety, depression, or other mood or behavior changes during a time of stress or transition. Usually, treatment for an adjustment disorder (like counseling) is covered under a person’s health insurance plan.

Those who are struggling with an anxiety disorder can also benefit from counseling, and sometimes also from medication. Certain types of counseling have been proven to be more effective in treating anxiety, including Cognitive Behavioral Therapy and Exposure therapy, which is often used to treat PTSD, OCD, and phobias.²

Online directories can be helpful in finding a therapist, and the filters can be used to find therapists who specialize in these treatments for anxiety and who are in-network with certain insurance plans.

Coping with Stress & Anxiety

Because stress and anxiety are so similar, the same coping skills and strategies are often helpful in reducing both. Because people experience stress and anxiety differently, the strategies that work for one person may not work for another. Sampling different strategies is often really helpful in identifying those that work best for you.

Those with high levels of stress and anxiety should seek professional treatment, but can still benefit from some of the strategies below ⁴.

• Regular exercise helps to rebalance some of the hormones and chemicals associated with stress and anxiety, as well as providing a healthy outlet for restless energy that often is experienced by people who are stressed out or anxious.
• Adequate sleep is essential for the brain and body, helping to restore balance, energy, mood, and improving all aspects of physical and cognitive functioning.
• Mindfulness and meditation are proven strategies to reduce stress and anxiety, and help train the mind to unhook from unhelpful thoughts and stories that feed into worry and stress.
• Social interactions are important for all aspects of physical and mental wellbeing, and have also proven to be important in helping people reduce stress and anxiety. Avoid giving in to the urge to withdraw and shut people out when you are going through difficult times.
• Set goals and work towards them, which will help you feel a greater sense of purpose, control, and direction. Because stress and anxiety are often centered around current and future problems, setting and working towards goals helps people stay in touch with positive aspects of life and maintain hope for the future.

Additional Resources for Stress & Anxiety

For more information on stress, anxiety, and resources to help reduce them, check out these resources:

• The American Institute of Stress: a website for information about stress, its effects on the mind and body, and an assessment to measure your stress levels.
• National Anxiety Foundation: a website providing free information about different kinds of anxiety disorders.
• National Alliance on Mental Illness: a foundation providing information, resources, advocacy and support for those struggling with mental illness
• Anxiety and Depression Association: a website with a wide range of information and resources for those struggling with different kinds of anxiety or mood disorders.
  • ADAA’s Screen for anxiety and depression